This paper provides an introductory overview of Childhood Apraxia of Speech (CAS), a neurological pediatric speech sound disorder characterized by impaired motor planning and coordination for speech. The paper draws on definitions from the American Speech-Language-Hearing Association (ASHA) and reviews current understanding of the disorder's neurological and genetic causes. It describes the key diagnostic characteristics of CAS, including the gap between receptive and expressive language abilities, and outlines a range of treatment approaches and teaching strategies — including motor learning principles, repetitive books, and sensory cueing — that can support children with this condition.
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According to Powell (2005), most of us take our ability to communicate for granted — we think of something to say, open our mouths, and the words come out. Even though it may appear simple, the communication process is in fact quite complex. The difficulty of human communication becomes particularly apparent when we consider the range of challenges faced by those for whom communication is difficult.
The American Speech-Language-Hearing Association (ASHA) defines Childhood Apraxia of Speech (CAS) as a neurological pediatric speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits — such as abnormal reflexes or abnormal tone. ASHA adds that CAS may occur as a result of known neurological impairment, in association with complex neurobehavioral disorders of known or unknown origin, or as an idiopathic neurogenic speech sound disorder (Childhood Apraxia of Speech, 2007).
Apraxia of speech is believed to be a neurogenic (neurologically based) speech motor disorder. Most children with apraxia of speech show no abnormalities on MRI scans; others may have definite damage to a part of the brain that contributes to the problem. Some children are born with such damage, while others acquire brain damage through accident or illness.
Over the past several years, researchers have increasingly recognized the role that genetics may play in childhood apraxia of speech. Some researchers believe it is likely that CAS is not caused by any single factor and that there may be different subtypes of CAS based on the particular underlying cause (Gretz, 2005).
Childhood Apraxia of Speech can be found in children who show no signs of difficulty with the strength or range of motion of their articulators, yet are unable to execute speech movements due to motor planning and coordination problems. This should not be confused with phonological impairments in children who have normal coordination of the articulators during speech (Apraxia, n.d.).
Gretz (2005) explained that a true developmental delay of speech occurs when a child follows the typical path of childhood speech development, but at a slower-than-normal pace. This rate sometimes corresponds with the child's cognitive skills. In standard speech and language development, a child's receptive and expressive skills advance in tandem. What is generally observed in a child with apraxia of speech, however, is a significant gap between receptive language abilities and expressive abilities. The child's ability to understand language (receptive ability) is broadly within normal limits, but his or her expressive speech is severely limited, absent, or highly indistinct.
This disparity is an important indicator that a child may be experiencing more than simply "delayed" speech, and the child should be evaluated for the presence of a specific speech disorder such as apraxia. It is worth noting, however, that certain language disorders may produce a similar pattern, and a gap between expressive and receptive language ability alone is not sufficient to diagnose CAS (Gretz, 2005).
"Treatment approaches, motor learning, and repetitive books"
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